Arthrodesis of the Ankle

Transcription

1 TM Arthrodesis of the Ankle

2 Plantar View of the Foot 1. Make a lateral incision to expose the tibia-talus joint and the talo-calcaneal joint. Prepare the arthrodesis sites surgically with a rasp or an osteotome to denude the arthrodesis sites for better union. 2. Make a plantar incision to expose the calcaneus for the insertion of a 2.5x300 mm Steinman pin, to serve as the guide wire for all subsequent steps. Drive Guide Wire 3. Align the tibia over the talus in the desired position before advancing the Steinman pin through either joint. The use of a C-arm is essential. The Steinman pin should be centered with respect to both the talus and the tibia. This step may require a slight forward shift of the tibia. Advance the Steinman pin according to the following guide. Stop advancing the Steinman pin after the corresponding limit for each FUZE length is reached.

3 Drill Fuze TM Path 4. Use a cannulated 7.5 mm drill with 2.5 mm cannulation to drill a hole from the plantar surface of the calcaneus through the talus and the articular surface of the tibia. Visualize the progress of the drill. The drill should reach the intramedullary canal of the tibia. 5. Remove the drill and use a cannulated orthopedic reamer to clear a path for the implant within the intramedullary canal. Start with the smallest reamer diameter and go to the next size depending on the FUZE size. The reamed hole diameter should not exceed the minor diameter of the implant s thread. 6. Push the foot against the tibia to compress the joints manually and to close the tibia-talus and talus-calcaneus gaps.

4 Implant Fuze TM 7. Insert the implant and drive it manually with the 5.5 mm hex cannulated screwdriver. Stop Advancing 8. Before the implant head reaches the calcaneus, and while the implant head is at least 20 mm outside the foot, remove the Steinman pin altogether and lock the hex screwdriver to the FUZE. Note the FUZE and the screwdriver lock together in only one position. Make sure there is no foreign material within the head cavity that might cause misalignment. Remove Guide Wire

5

6 Lock Driver to Fuze TM

7 Lock Driver to Fuze TM 9. Continue to advance the FUZE with the hex screwdriver. 10. When the middle thread of the implant engages the distal tibia and the head engages the calcaneus, the talus-tibia and talus-calcaneus joints tighten at first. When the middle thread clears the talus, the implant compresses the joints. 11. Advance the implant until the FUZE head is flush with the bone surface. The notch in the hex screwdriver handle should face towards the toes. Attaching Targeting Tool 12. Attach the Targeting Frame/Jig to the FUZE head. Align the notch of the implant with the protrusion pin in the middle leg of the metal support of the Targeting Frame/Jig.

8 Attaching Targeting Tool Alignment Notch

9 Targeting Tool Mounted

10 Targeting Tool Mounted

11 Targeting Tool Locked NOTE: The FUZE-screwdriver assembly locks into the Targeting Frame/Jig in only one position. Tighten the locking nut to secure the Targeting Frame/Jig to the FUZE-hex screwdriver assembly. Locking Nut

12 Targeting Tool Locked Plantar View Locking Nut

13 Introducing Locking Screws 9. Insert the 150 mm drill guide P460-35A into a proximal Targeting Frame/Jig hole (corresponding to the leading tip of the implant). Insert a 3.5 mm drill, Z , into the drill guide and drive it into the tibia, through the FUZE, and into the distal wall of the tibia. The drilling provides a pilot hole for the 5.0 mm locking screws. Proximal LM Hole Distal LM Hole

14 Measuring Screw Length

15 Introducing Locking Screws 14. Insert the 150 mm drill guide P460-35A into a proximal Targeting Frame/Jig hole (corresponding to the leading tip of the implant). Insert a 3.5 mm drill, Z , into the drill guide and drive it into the tibia, through the FUZE, and into the distal wall of the tibia. The drilling provides a pilot hole for the 5.0 mm locking screws.

16 Proximal Locking Screws 15. Finish the placement of cross screws as desired. Vilex recommends the insertion of at least 4 four screws: two distally through the tibia, one within the middle thread, and one through the calcaneus. Proximal LM Screw Proximal AP Screw

17 Distal Locking Screws 16. Add more screws as desired. Screw the end cap and close. Distal LM Screw Distal LM Screw

18 Distal Locking Screws 16. Add more screws as desired. Screw the end cap and close. Inserting Slanted Screw From Talus to Calcaneus

19 Distal Locking Screws 16. Add more screws as desired. Screw the end cap and close. Advance Drill through Heal & Retrograde

20 All Screws Inserted Fibula Removed

21 The Fuze TM Tray Tray Cover

22 The Fuze TM Tray Top Tray

23 The Fuze TM Tray Lower Tray Screw Tray